How Congress Can Quickly Make Wegovy, Ozempic Affordable
Robert Pearl, M.D.
Author of "ChatGPT, MD" | Forbes Healthcare Contributor | Stanford Faculty | Podcast Host | Former CEO of Permanente Medical Group (Kaiser Permanente)
A whopping 1 in 8 U.S. adults have taken GLP-1 drugs like Wegovy and Ozempic for weight loss and related conditions. Their popularity and efficacy have sparked a prescription-writing frenzy, leaving both medications on the FDA’s drug shortage list since May 2023.
However, even when supplies rebound, access to these drugs will remain out of reach for the majority of Americans. That’s because brand-name GLP-1 medications range from $11,000 to $16,000 a year, prices that are unaffordable for most people.
Attempts to control prices through legislation face significant hurdles, both in the divided halls of Congress and in the courts, where determined legal challengers await. Senator Bernie Sanders, chair of the Senate Health Committee, hopes that applying pressure at upcoming hearings will force GLP-1 producers like Novo Nordisk, maker of Wegovy and Ozempic, to lower prices voluntarily. History shows that pharmaceutical companies rarely bend on prices, even in the face of public scrutiny. ?
Fortunately, Congress can implement a straightforward solution to make these drugs affordable, thereby improving the nation’s financial and physical health. Before explaining that strategy, here’s why our nation badly needs an effective, affordable and available weight-loss medication.
Framing The Obesity Epidemic
Around 42% of American adults are obese, putting them at significantly elevated risk for a host of complications: diabetes, heart disease, kidney failure, leg amputation, cancer and severe musculoskeletal problems. The economic impact of obesity is staggering, with related healthcare costs estimated to be $260 billion annually.
For decades, health experts have pled with Americans to exercise more, eat better, and make lifestyle improvements while urging lawmakers to regulate food and address the “social determinants of health.” Currently, taxpayers spend billions on government-run nutrition and exercise campaigns—on top of the $190 billion Americans dole out for weight loss products, diet programs and nutrition supplements.
Despite these extensive efforts and expenditures, obesity rates continue to climb, as do the associated consequences, contributing to as many as 500,000 preventable deaths every year .
The Outsized Promise Of GLP-1 Drugs
Studies show that all GLP-1 drugs lead to major weight loss, averaging 15% of a user’s body mass. And when obese individuals combine regular exercise with semaglutide, the active ingredient in Wegovy, they shed an average of 34 pounds .
Beyond weight loss, GLP-1 medications have been shown to reduce the incidence of diabetes and cardiovascular events , prevent kidney failure and potentially improve cognitive function in patients with Alzheimer’s.
Regardless of these known and potential benefits, the high price of weight-loss medications forces insurers and employer health plans to limit coverage, leaving many patients without access to these beneficial solutions.
The Financial Burden
The cost of providing 100% of obese Americans with GLP-1 medications would surpass $1 trillion a year , even with drug rebates. For perspective, that’s more than twice what Americans spend on all prescription drugs annually. Moreover, that figure dwarfs the $260 billion in projected savings if obesity were eradicated.
And because patients who stop taking the medication regain an average of two-thirds of the weight they’ve lost, that trillion-dollar annual cost would persist indefinitely. From the vantage of the U.S. healthcare system, this ongoing expense (creating an estimated 25% bump in total healthcare spending) would strain funding for other vital components of care, including hospitals and clinicians. It would also drive insurance premiums and out-of-pocket costs through the roof.?
It’s important to note that GLP-1 drugs have mild to moderate side effects , and they are not a silver bullet for obesity. But in conjunction with lifestyle changes, these medications would significantly improve national health and save thousands of lives—if they were affordable.
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A recent report from the office of Sen. Sanders highlighted the stark disparity in global pricing for GLP-1 medications: Americans pay over $1,300 for a 28-day supply of Wegovy while patients pay far less in countries like Denmark ($186), Germany ($137) and the UK ($92).
This is because nearly all national governments, except for the U.S., negotiate the price of prescription medications, rather than allowing drug companies to charge whatever they deem best for their shareholders.
In response to criticisms about its expensive GLP-1 drugs, Novo Nordisk said its prices reflect substantial R&D investments . The company also notes that prices are already 40% lower than list with rebates. To date, however, the drugmaker has neither explained why Americans should bear nearly all the financial burden nor provided details on the R&D spend. This lack of transparency raises questions about Novo Nordisk’s justifications.
According to the company’s annual report, Novo Nordisk generated $18 billion in sales last year from its weight-loss medications. With extensive patent protections on Wegovy and Ozempic, those exorbitant profits will continue for at least another decade, unless Congress acts.
The Hidden Truth
Contrary to what people might assume, these drugs are not expensive to make. A team of Yale and Harvard scientists determined that semaglutide can be manufactured for less than $5 per month .
In May 2024, telehealth company Hims & Hers began selling a compounded (pharmacist created) version of the GLP-1 drug semaglutide for $199 per month, about 85% less than the brand-names Wegovy and Ozempic. This reflects a profitable, but more appropriate, price point.
Hims & Hers can currently sell its version of these weight-loss drugs because Congress has authorized the compounding and sale of patented medications when there is an FDA-determined drug shortage. However, once the GLP-1 shortage is resolved, companies like Hims & Hers will be required to cease production. This will compromise the health of current users and price out many more Americans still struggling to lose weight.
A Creative Solution For The FDA And Congress
The easiest way for Congress to make these lifesaving weight loss medications affordable for all eligible Americans would be to expand the FDA’s definition of “drug shortage.” Whereas “shortage” currently refers only to inadequate supply, a more modern definition would include medications that are unaffordable and therefore inaccessible to millions of people.
By amending the Food, Drug, and Cosmetic Act, this expanded definition would allow compounded versions to remain available at a reasonable price, even when weight-loss drug manufacturers increase production.
The reason drug manufacturers price GLP-1s at $10,000 to $16,000 a year has little to do with R&D, overhead or manufacturing costs. The reason is simple: greed. Such pricing strategies might be tolerable in other industries, but when the health of tens of millions of Americans is at risk, Congress has an obligation to act.
Expanding the definition of “shortage” would break the monopolistic hold of current manufacturers, improve public health, save lives, and incentivize GLP-1 manufacturers to reduce prices. The time for legislative action is now.
For more insights on these issues, check out these recent posts and past editions of "Breaking The Healthcare Rules" here on LinkedIn:
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4 个月The value of reducing metabolic disease including obesity & downstream effects is much greater than $260 billion. In time, it could be a >$1T in annual medical savings + societal benefits. Given this, we should debate GLP-1 pricing in terms of the bigger goal of restoring metabolic health. The drugs shouldn't only be cheaper initially but everyone in the system should be aligned to share in the value of improved outcomes. I've proposed annuitized, outcomes-based pricing with a low upfront price (< $2k) plus age-based yearly payments after an initial period tied to recipients' outcomes. This drives pharmas to care how their drugs are used and results. If outcomes are great, great. If not, they - & everyone else - does less well. We need new drug pricing models that align product makers, providers, participants (my word for patients), and payors. Pushing down upfront prices, alone, will increase access in the near-term (good!) but without increasing the odds that recipients will get the other services and supports necessary to achieve long-term metabolic health. (More info on proposed pricing here: https://www.statnews.com/2023/12/06/weight-loss-drugs-price-wegovy-zepbound-glp-1s-medicare-cost/)
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4 个月This is a powerful and well-written piece about the challenges of tackling obesity in the US. Here's how you can incorporate AI while keeping the core message strong: While the main focus is on making GLP-1 medications affordable, you can acknowledge AI as a possible area for future exploration. Here's how: - Briefly mention that alongside broader efforts to address obesity, AI might play a role in developing personalized interventions in the future. For instance, AI could analyze data to recommend the most effective diet, exercise plan, or medication (when affordable) for each individual. - However, it's important to maintain the primary emphasis on advocating for the proposed legislative solution to make GLP-1 medications accessible now. AI can be a future consideration, but affordability is the immediate concern.
High-Performance Lean Body Specialist | Guiding driven CEOs and Executives to get fit & shed 15-30 lbs of body fat in 90 days—no gimmicks, just results—using our Lean Body Pipeline system.
4 个月Obesity is not an American problem. By definition, an individual is obese if they have a BMI of 30 or more. The two primary variables that affect BMI are height and weight, thus most body builders are classified as obese. ?? IMO, Making Wegovy and Ozempic more affordable is not the solution. They can be free and still not work for a majority of individuals. If these drugs actually work then they wouldn’t need to ask their customers to combine them with a healthy and fit lifestyle. Eating well and moving often alone can make a larger impact towards health and fitness, and can act as both a preventative and corrective solutions.
MEDICARE DOES NOT PAY FOR LONG TERM CARE Co-Founder of 65andMe LLC - Dedicated to Medicare, aging policy and services.
4 个月Operation Warp Speed?
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4 个月Robert Pearl, M.D. excellent “wake Up” paper on the high cost of drugs. Ye stop amending the sedition of FDA’s drug shortage rules. On target!!! Hoping generics shouldn’t be far behind .